Inadequate acid suppression has been associated with H pylori eradication failure. Therefore, it is advisable to consider using high-dose and more potent PPIs; PPIs that are not metabolized by CYP2C19; or potassium-competitive acid blockers, if available, in patients with refractory H pylori infection.
There are some promising data for nonantibiotic adjuncts, such as probiotics, in the treatment of H pylori infection. While the existing data are mostly positive, there are limited data to guide appropriate patient selection, optimal timing, formulation, dosage, and duration. More rigorous investigation would be valuable.
When used in clarithromycin-based triple therapy, dividing 2-3 mg of amoxicillin into at least three doses daily has been shown to avoid low trough levels and to improve the efficacy of eradication therapy.
Learn more about the management of H pylori infection.
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Cite this: Steven F. Moss, Cristian Puerta. Fast Five Quiz: Management of Helicobacter pylori - Medscape - Oct 18, 2023.